title: Depo-Provera and skeletal health: a survey of Florida obstetrics and gynecologist physicians.
abstract: OBJECTIVE
  In November of 2004, the US Food and Drug Administration (FDA) issued a black box warning regarding skeletal health concerns with depot medroxyprogesterone acetate (DMPA) contraception. This FDA labeling change has the potential to impact how this contraceptive is used. Our goal was to assess the impact of the FDA decision on how Florida obstetrician-gynecologists prescribe DMPA.
  
  
  METHODS
  A survey was conducted with questions and case scenarios regarding the use of DMPA before and after the black box warning. The survey was sent to all members of the Florida Obstetric and Gynecologic Society.
  
  
  RESULTS
  Four hundred twenty-five surveys were mailed and 149 were returned - a 35% return rate. Forty-six percent of physicians surveyed indicated that they place a time limit on DMPA use, and 66% stated that this limit was based on the FDA black box warning. Sixty-five percent of respondents ordered bone mineral density (BMD) testing solely due to the use of DMPA, with 58% indicating that this decision was based on the black box warning. Eight (5.4%) of the respondents indicated they selectively prescribe bisphosphonates for patients based solely on the use of DMPA, while 33% of respondents state that they use estrogen supplementation. There was a trend towards fewer DMPA injections per week after the black box warning as compared to before; however, this trend was not statistically significant (p<.125).
  
  
  CONCLUSIONS
  Respondents may be writing fewer prescriptions for DMPA, are likely to institute a time limit on said prescription and are likely to order BMD testing, using the black box warning as justification. Continued education is necessary to prevent inappropriate restrictions on DMPA use and the performance and/or prescription of inappropriate tests and medications.
authors.affiliation: Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA. sarah.paschall@jax.ufl.edu
authors.forename: Sarah
authors.initials: S
authors.lastname: Paschall
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kaunitz
mesh_terms: D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D004164:Diphosphonates / Q000627:therapeutic use; D004348:Drug Labeling; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006176:Gynecology; D006306:Health Surveys; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D009774:Obstetrics; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D050071:Bone Density Conservation Agents; D003271:Contraceptive Agents, Female; D004164:Diphosphonates; D017258:Medroxyprogesterone Acetate